quiz 1
A 4-year-old child is found to have Hirschsprung disease (aganglionic megacolon), and the healthcare provider prescribes a special diet. The nurse is assigned to provide dietary instructions for the parents. What diet will the nurse be teaching the parents
A low-residue diet is important to prevent the development of bulk, which will further irritate the colon. There are no recommended changes in the amount of fat in the diet. A high-fiber diet is contraindicated because it may cause an obstruction. To maintain or improve the child's nutritional status, calories should not be restricted.
A nurse is assessing a 4-year-old child. What age-appropriate language skills does the nurse expect the child to have fulfilled
Because of developing cognitive abilities, 4-year-old children can form six- to eight-word sentences. Because of expanded experiences and developing cognitive ability, the 4-year-old should have a vocabulary of approximately 150 to 200 words. The use of appropriate grammar does not develop until 9 to 12 years of age. By 5 to 6 years of age, children ask the definitions of new words; 4-year-olds have not yet achieved this level of development. By 4 to 5 years of age a child's speech is intelligible, although sounds such as "ch," "th," "sh," "z," "r," and "l" are frequently imperfect.
Which is likely to impact a child's drawing near the end of the preschool stage of development
Culture and environment are thought to impact a child's drawing near the end of the preschool stage of development as all drawings tend to look the same until the end of this stage. Disease, physical growth, and hand dominance are not thought to impact a child's drawing.
A nursing instructor asks a nursing student about the sleep patterns of preschoolers. Which statements made by the student indicate a need for more education
. Daytime naps are rarely seen in preschoolers. Partial awakening followed by a normal return to sleep is frequent. Bedwetting can be seen in some preschoolers. On an average, a preschooler sleeps about 12 hours a night. About 20% of the sleep time in preschoolers is the rapid eye movement sleep (REM) cycle.
A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). What signs and symptoms does the nurse expect when obtaining the health history and performing a physical assessment
Anorexia occurs as a result of catabolism. Platelet count is decreased because of bone marrow depression, resulting in bleeding tendencies; petechiae and ecchymoses result. Edema is not expected with ALL. Alopecia is not related to the disease process; it occurs as a result of chemotherapy. The red blood cell count is decreased because of bone marrow depression; the child will be lethargic and sleep excessively.
Which characteristics observed in a five-year-old child are appropriate
Five-year-old children may begin to swim and skate. They are interested in trying new foods and can easily draw triangles and diamonds. Toddlers may get involved in parallel play. Four-year-old children have finicky eating habits.
At what age should a nurse instruct a parent that his or her child will have finicky eating habits
Four-year-old children have finicky eating habits. Toddlers (one- and two-year-old children) often develop the desire to eat one food repeatedly. Five-year-olds are more interested in trying new foods.
Which between-meal snack should a nurse tell the parents of a preschooler with a urinary tract infection to offer their child
A high-protein, high-carbohydrate snack provides additional nutrients to combat an infection and a fever. Also, fluid helps flush the urinary tract. Fruit does not provide the protein needed for the healing process. Candy provides empty calories. A cream soup is too heavy for a between-meal snack and does not provide the needed protein.
What statements would a nurse include in a safety promotional program to educate the parents of preschoolers
A nurse should educate parents to teach their children about basic physical safety rules such as the proper use of safety scissors, never running with an object in their mouth or hand, and never attempting to use the stove or oven unassisted. A nurse should also instruct parents to remove doors from unused refrigerators and freezers because if a child cannot freely exit from appliances, asphyxiation can occur. Having a child sleep on his or her back or side helps to avoid the risk of sudden infant death syndrome. This advice is helpful for infants rather than preschoolers. Preschoolers should be instructed not to talk to strangers to reduce the risk of injury and stranger abduction. Preschoolers should be taught how to cross roads and walk in parking lots to acquaint them to traffic rules and lower the risk of car accidents.
A healthcare provider writes prescriptions for a young child with a tentative diagnosis of Wilms tumor. Which prescription should the nurse question
A renal biopsy is an invasive procedure. In the early stages, Wilms tumor is encapsulated. Any disruption of the tumor capsule may precipitate metastasis. Magnetic resonance imaging, computed tomography, and abdominal ultrasound are all helpful in making the diagnosis.
Which does the nurse explain is true about preschoolers
The diet of preschoolers consume about half of average adult portion sizes. They need approximately 1800 calories on a daily basis. Preschoolers are over-particular about their food at 4 years of age. At the age of 5 years, they typically become more interested in eating different foods. The physical growth of preschoolers is slower than cognitive and psychosocial development.
At which age should the nurse anticipate that the preschool-age client will begin to participate in the social side of eating
The nurse anticipates that the preschool-age client will participate in the social side of eating at 5 years of age. The 3-year- and 4-year-old clients are not expected to participate in the social side of eating. The 6-year-old client is expected to already be participating in the social side of eating.
Which priority actions should the nurse implement when providing care to a preschool-age child who presents in the emergency department (ED) after an accidental overdose
The priority nursing actions when providing care to a preschool-age client who presents in the ED after an accident overdose include monitoring vital signs, assessing mental status, and initiating CPR, if needed. Clearing the mouth of remnants and questioning the parents are not the priority actions by the nurse in this situation.
Which data should the nurse anticipate when conducting a developmental assessment for a 5-year-old client
When conducting a developmental assessment for a 5-year-old client, the nurse anticipates the client to be able to name coins correctly, tie shoe laces independently, and have established hand dominance. A vocabulary of 1500 words would indicate a language delay; the 5-year-old client is expected to have a vocabulary of 2100 words. Participation is associative, not parallel play, and is expected by 5 years of age.
Which nursing interventions are appropriate while caring for a preschooler exposed to lead poisoning
While caring for a preschooler exposed to lead poisoning, the nurse should administer the local anesthetic procaine, prevent further exposure of the child to lead, and identify the sources of lead in the environment. In an attempt to identify the source of the lead, the nurse should educate parents to use cold water, instead of hot water, while cooking. The nurse should administer chelating agents into a large muscle mass.
The nurse is caring for a preschooler diagnosed as suffering from frequent episodes of sleep terrors. Which statements describing the nature of sleep terrors does the nurse know to be true
Sleep terrors occur usually 1 to 4 hours after falling asleep, when non-REM sleep is deepest. After an episode, the child rapidly returns to sleep; it is often difficult to keep the child awake after this. Nightmares are followed by full waking; sleep terrors are followed by a partial arousal. Nightmares take place during REM sleep; sleep terrors take place during state IV, non-REM sleep. After a nightmare, the child is aware of and reassured by another's presence. After an episode of sleep terrors, however, the child is not very aware of another's presence, is not comforted, and may push the person away and scream and thrash more if held or restrained.
Which statement is true about the sleep pattern of preschoolers
The average preschooler sleeps about 12 hours a night. By the age of five, children rarely take daytime naps except in cultures in which a siesta is the custom. Partial awakening followed by a normal return to sleep is frequent. About 30% of an infant's sleep time is in the rapid eye movement sleep (REM) cycle.
What is the maximum recommended intramuscular dose for medications in preschoolers
The maximum recommended intramuscular dose in preschoolers should not exceed 1 mL.
A nurse is caring for 3-year-old children. At what stage of cognitive thought does the nurse expect them to be
According to Piaget, at approximately 2 years of age the toddler enters the preconceptional phase of cognitive thought, which lasts, at most, until about 4 years of age; the preconceptional phase is a subdivision of the preoperational stage, which lasts from 2 years to 7 years of age. Four-year-old children are in the stage of intuitive thought, which gives rise to imaginative play. Abstract thought is developed during the adolescent ages of 15 years to 20 years. Concrete operational thought occurs in school-age children when they perform actions mentally rather than through behavior, as in the earlier years.
A nurse prepares a chart listing the methods of treatment of different types of poisoning in preschool children. Which preschooler's entry needs to be corrected
Activated charcoal is contraindicated for the treatment of corrosive ingestion because it may infiltrate burned tissue. While treating iron poisoning, a whole bowel irrigation may be used if radiopaque tablets are visible on an abdominal X-ray. To treat plant poisoning, the skin or eyes exposed to the poisonous plant should be washed. Metabolic acidosis caused by aspirin poisoning can be treated with sodium bicarbonate transfusions.
Which question should the nurse ask the parents of a 3-year-old client to assess fine motor skills
The nurse would ask the parent of a 3-year-old if the child is able to build a tower using 9 or 10 blocks to assess fine motor skills. A preschool-age child is not expected to use scissors, also a fine motor skill, until 4 years of age. Riding a tricycle and climbing stairs using alternate feet are both gross, not fine, motor skills.
The nurse notes that a 4-year-old child is having difficulty relating to some of the children in the playroom. What does the nurse identify as the reason that this problem is not unexpected
It is common for 4-year-old children to boast and exaggerate and to be impatient, noisy, and selfish. More advanced, cooperative play is expected of 4-year-old children. Extreme dependence on parents is unusual in 4-year-old children because they are striving for more initiative and less dependence. The toddler's tendency toward tantrums and negativism should have waned by 4 years of age.
A busy work-at-home parent reports little time to interact with preschool children who become easily bored. Which activity is best for the nurse to recommend to keep the children occupied for long periods
Physical activity has an important role in prevention of obesity and promotion of health, so activities that incorporating running, jumping, and other physical exercise should be encouraged. Interactive physical activities such as tag and hide-and-seek promote social skills. Some sedentary activities have an important role for children also but are appropriate for shorter periods.
Which characteristics does the nurse assess from the drawings of a preschooler
The nurse may use drawing as a tool to assess intelligence, personality development, and psychosocial adjustment of children. A child's temperament can be assessed by interacting with the child. The nurse may check a child's attention span while assessing the child for school readiness.
Which interventions should the nurse recommend for a preschool-age client who is biting other children at daycare
Appropriate interventions for a child who is biting others at daycare include separating the child from the situation, enquiring about child's sleep (lack of sleep is a common cause for this behavior), telling the child that is it not okay to hurt another person, and using a time-out as discipline for the behavior. Distraction is not appropriate for a child who is exhibiting behaviors that include other people, such as biting.
A nurse prepares a chart comparing the language development of four preschoolers. Which child may have developed advanced language skills
Children learn the names of days of week and months by the age of five years, not four years. Therefore preschooler B has developed advanced language skills. Three-year-old children use complete sentences of three or four words. Four-year-old children use sentences of four or five words. Five-year-old children use sentences of six to eight words, with all parts of speech.
A nurse is assessing a 4-year-old child. In what stage of Erikson's psychosocial development does the nurse expect the child to be in the process of achieving
The development of initiative is part of Erikson's early childhood or preschool stage, which includes children 3 to 6 years of age. The development of trust is part of Erikson's infancy stage, which includes children from birth to 1 year of age. The development of industry is part of Erikson's middle childhood or school-age stage, which includes children 6 to 12 years of age. The development of autonomy is part of Erikson's toddler stage, which includes children 1 to 3 years of age.
A 3.5-year-old child begins to scream and kick when a laboratory technician arrives to draw blood. The nurse understands that this reaction primarily is a result of the child's what
The preschooler is terrified by intrusive procedures and views them as a punishment for curiosity and fantasies. A child of this age does not fear loss of control. A child of this age does localize pain, even if he or she is unable to express it. There is no evidence that the child has had blood drawn previously.
Which nursing actions are developmentally appropriate when caring for a hospitalized preschool-age child
When providing care to a preschool-age client who is hospitalized, the nurse should use toys for distraction during a painful procedure and offer medical equipment for the client to play with prior to a procedure. Brochures are not an age-appropriate teaching strategy for the preschool-age client. Knocking on the door prior to entering the room is a hospital policy and not developmentally appropriate care. Instructions for any procedure should be provided just prior to initiation when caring for a preschool-age client.
Which nursing action is the priority when administering chelation therapy for a preschool-age client
Adequate urinary output must be ensured with administration of calcium EDTA, the medication used for chelation therapy. Clients receiving the drug intramuscularly must be able to maintain adequate oral intake of fluids. Monitoring vital signs, conducting a behavioral assessment, and providing education to reduce lead exposure are not priority nursing actions when administering chelation therapy.
Which statements by the parent of a 4-year-old client would indicate correct understanding related to expected gross motor skill development during this stage of development
Gross motor skills that are expected by 4 years of age include jumping rope, riding a tricycle, and throwing a ball underhand; the parental statements reflective of these skills indicate correct understanding of gross motor skills during this stage of development. Skating with good balance and skipping and hoping using alternate feet are not expected until 5 years of age; therefore, the parental statements reflective of these skills indicates the need for further education by the nurse.
A nurse plans to take the temperature of a 4-year-old child with a diagnosis of leukemia who has a fever. Which thermometers with the most accurate results can the nurse use safely for this child
The infrared thermometer can be used on the tympanic membrane; it is safe to use for a child with leukemia. The chemical dot or liquid crystal skin contact thermometer is a flexible, one-use, disposable thermometer. It can be used to take oral or axillary temperatures and is safe for use in a child with leukemia. Rectal temperature taking is contraindicated in children with leukemia because it may result in trauma to the rectal mucosa. Also, the use of a rectal probe may be perceived as an intrusive procedure by a 4-year-old. Most digital thermometers can be used to take oral, axillary, or rectal temperatures. An oral temperature with an electronic thermometer is not safe or accurate for a 4-year-old; it is considered safe for a child who is at least 5 years old. The ear-based sensor thermometer is used in ambulatory settings; its reliability is a matter of some controversy.
A nursing instructor asks a nursing student about tips for examining a 4-year-old sick child. Which statements made by the nurse indicate adequate teaching
While examining a 4-year-old, the nurse should let the child play for some time so that the child may get acquainted to the new surroundings. This action will increase child's cooperative behavior. The nurse should start the examination with nonthreatening areas like the fingers or hands. Information related to the child's sickness is gathered from the parents or guardians. The nurse should call the child by his or her first name and address the parents as "Mr.," "Ms.," or "Mrs." The nurse should refrain from passing judgment when parents explain about their child's illness.
A 3-year-old child is seen in the emergency department after a fall off a swing, and a possible concussion is diagnosed. When using the Glasgow Coma Scale, what should the nurse remember about most children 3 years of age
Without rituals, preschool children (3 years old) are unable to maintain autonomy. Strange environments often cause the child to regress, resulting in the child not talking to strangers. Preschool children do not have the cognitive ability to remember and recite a home address. They do not have a concept of time. Assessment should be performed with a parent present (except in the case of suspected child abuse) because parents are sources of security and therefore part of the child's ritual.
Which fears should the nurse include in a teaching session for the parents of a preschool-age client during a scheduled health maintenance visit
Fears that often occur during the preschool stage of development include ghosts, the dark, large dogs, and objects associated with pain; therefore, the nurse should include this information in the teaching session with the parents during the health maintenance visit. Poor academic performance is not a fear that preschool-age clients experience; this is more common during school-age and adolescence.
A nurse educates a mother about how to help a stressed preschooler. Which information is the nurse most likely to provide
In the time of stress, preschoolers want their parents to feed, dress, or hold them. Preschoolers get stressed about the birth of a new sibling. The mother should not plan to send her child to playschool because the new location will increase the child's stress. During times of stress, preschoolers may perform thumb sucking. This is considered as normal coping behavior.
A nurse is educating the parents of a preschooler about the importance of play in the development of their child. Which statements made by a parent indicates the need for further teaching
Television, videos, electronic games, and computer programs support development and the learning of basic skills. There should be limited use of these items for preschoolers, but these need not be completely avoided. Imaginary playmates are a sign of health and allow the child to distinguish between reality and fantasy. The parents should know that playing helps the child to socialize with others. Pretend play allows children to learn to understand others' points of view, develop skills in solving social problems, and become more creative. Playing also serves as a medium for the child to release frustration.
How should a nurse assess a 4-year-old child with abdominal pain
The child with abdominal pain may assume the side-lying position with the knees flexed to the abdomen or self-splint when moving. A 4-year-old may be unable to identify the exact location of the pain; in addition, the pain may be generalized rather than localized. Auscultation may be included in the physical assessment, but it is not specific to the assessment of pain. Questioning the parents may be included when the nurse is taking the health history, but it is not specific to the current assessment of pain.
A preschooler who is allergic to environmental pollutants is to be given a hyposensitization injection. What clinical finding prompts the nurse to withhold the injection
The introduction of an additional allergen may increase the severity of the child's respiratory distress and cause a life-threatening reaction. Serous otitis media is a chronic problem among children; it is insufficient justification for withholding the injection. Conjunctivitis is a sign of an allergic response; the injection should be given as long as respiratory problems are not present. A rash on the face and neck is a sign of an allergic response; the injection should be given as long as respiratory problems are not present.
A nurse is caring for a 5-year-old child who is a victim of physical abuse. Which interventions are appropriate while talking to the child to help reveal the abuse
While asking the preschooler to reveal abuse, the nurse should discuss the body parts using words that the child will understand. The nurse should tell the child that it is not the child's fault and no one is going blame the child. The child should also be told that it is a good thing to report about the incident to the nurse, as it is required by law that the nurse report the incident. The nurse should limit the interview to the child's physical and mental health concerns and not ask about the family's social or legal problems. Physical abuse can also be caused by parents; therefore a private time and place should be provided for the abused child to talk.